New WHO recommendations to prevent TB aim to save millions of lives

March 25, 2020

In honor of World Tuberculosis (TD) day, the World Health Organization (WHO) issued new guidelines on preventive treatments to address latent TB infections.

The WHO estimates that a quarter of the world’s population is infected with TB bacteria. While they are not sick or contagious, they are at higher risk of developing TB disease.

“COVID-19 is highlighting just how vulnerable people with lung diseases and weakened immune systems can be,” said WHO Director-General Tedros Adhanom Ghebreyesus, MD. “The world committed to end TB by 2030; improving prevention is key to making this happen. Millions of people need to be able to take TB preventive treatment to stop the onset of disease, avert suffering and save lives."

Although some progress has been made towards targets set at the UN high-level Meeting on TB in 2018, TB preventive treatment has been largely neglected, the WHO said .At the meeting, global leaders committed to ensuring access to TB preventive treatment to at least 24 million contacts of people with active TB and 6 million people living with HIV by 2022. To date, only a fraction of that target has been reached, with countries putting less than 430,000 contacts and 1.8 million people on TB preventive treatment in 2018.

The new WHO consolidated guidelines recommend a range of approaches such as: 

•             A scale-up of TB preventive treatment among populations at highest risk including household contacts of TB patients, people living with HIV and people at risk with lowered immunity or living in crowded settings. 

•             Integration of TB preventive treatment services into ongoing case finding efforts for active TB. All household contacts of TB patients and people living with HIV are recommended to be screened for active TB. If active TB is ruled out, they should be initiated on TB preventive treatment.

•             Use of either a tuberculin skin test or interferon-gamma release assay (IGRA) to test for TB infection. Both tests are helpful to find people more likely to benefit from TB preventive treatment but should not become a barrier to scale-up access. Testing for TB infection is not required before starting TB preventive treatment in people living with HIV, and children under five years who are contacts of people with active TB. 

•             Use of shorter options for preventive treatment in addition to the widely used six months of daily isoniazid. The shorter options that are now recommended range from a one-month daily regimen of rifapentine plus isoniazid to three months weekly rifapentine plus isoniazid, three months daily rifampicin plus isoniazid, or four months of daily rifampicin alone.

In February, the Centers for Disease Control and Prevention (CDC) also outlined preventive treatments for latent TB infections, endorsing three of the shorter regimens. The CDC recommends three months of weekly isoniazid plus rifapentine (adults and children older than two years, including HIV-positive patients), four months daily rifampin (HIV-negative adults and children of all ages). and three months of daily isoniazid plus rifampin (adults and children of all ages and for HIV-positive patients).

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